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Form 73a802 - Application For 90-Day Extension Of Time To File Kentucky Bank Franchise Tax Return - 2017

73A802 (1-17)

FOR OFFICIAL USE ONLY

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

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2 0 1 6

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RTN

Type

Period

Tax

Return

APPLICATION FOR



90-DAY EXTENSION OF TIME TO FILE

KENTUCKY BANK FRANCHISE TAX RETURN

_ _

_ _ _ _ _ _ _

Name

RTN (Routing and Transit Number)

Mailing Address

Federal Identification Number

_ _

_ _ _ _ _ _ _

—

Telephone Number

(

)

City

State

ZIP Code

1. Tentative payment of bank franchise tax due (see instructions) ..................................................



2. If remitting payment by electronic funds transfer (EFT), check here

and enter amount ........

➤ Make check payable to Kentucky State Treasurer and mail extension request with payment to:

Kentucky Department of Revenue

Mailing Address:

P . O. Box 1303, Frankfort, KY 40602-1303

Overnight Address:

501 High Street, Frankfort, KY 40601-2103

Telephone Number:

(502) 564-2198

Extensions are granted in accordance with the provisions of Kentucky Revised Statute 136.545.

Signature of Principal Officer or Chief Accounting Officer

Signature of Preparer Other Than Taxpayer



Type or Print Name of Principal Officer or Chief Accounting Officer

Telephone Number

Extension

Date

The 2016 Kentucky bank franchise tax return must be postmarked no later than March 15, 2017,

unless an extension of time to file the return is submitted by that date. If a 90-day extension of time

is requested, the 2016 Kentucky bank franchise tax return must be postmarked no later than June

13, 2017. An extension of time to file a return does not extend the time for payment of the tax due.

Form 73a802 - Application For 90-Day Extension Of Time To File Kentucky Bank Franchise Tax Return - 2017

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